As part of State election lobbying, the Australian Medical Association's president, Shaun Rudd, said Queensland was fighting the "war on wobble" and "tuckshop lady arms" were evidence of unhealthy foods being served to school children.

"The school tuckshops are supposed to be healthy places, but the reality is, they aren't," Dr Rudd said.

Doogie Howser wowser: Teenager busted at Florida hospital after playing doctor for a month

A TEENAGER posing as a doctor managed to fool workers at a Florida hospital for a month before he was caught out, even sitting in on an obstetrics exam.

The 17-year-old wannabe Doogie Howser was arrested by West Palm Beach police last week after staff inside the OB/GYN office were alerted by a patient that a “young black male who appeared to be a child was dressed as a doctor”.

The boy, whose name was withheld, had been walking around wearing a white doctor’s lab coat and carrying a stethoscope telling people he was a doctor, police said.

When confronted by officers called to St. Mary’s Medical Center, he told them he had been a doctor for “years” and that “his whole family knows he is a doctor”, according to the police report published by The Smoking Gun.

A security officer told police the boy was “known around the hospital as a doctor”, with multiple witnesses saying he had been seen walking around the hospital for approximately one month.

Surveillance video showed him “walking around hospital wings, but never entering any rooms or seeing any patients”, the police report said.

Nurses at the OB/GYN outpatient centre told police the boy had been inside an exam room while Dr Sebastian Kent conducted a patient examination. Dr Kent later discovered a note written by the boy on his desk, asking if he could “shadow” him.

When called to collect her son, the young man’s mother said he was under care for an undisclosed illness but refuses to take any medication.

Police confiscated his lab coat and all medical items but on agreement with hospital officials declined to pursue charges, The Smoking Gun reports.

Further investigation revealed the boy had also been spotted at a second hospital, the good Samaritan Medical Centre, where the hospital’s security director said she remembered a “younger black male dressed as a doctor walking out of the Emergency Room entrance” the previous week.

After searching the teenager’s van, police discovered a white lab coat with “Natural Medicine” embroidered on the chest, along with a “black doctor or nurse scrub-style top”.

EVERYONE knows the joke about the bloke asking for directions to Dublin — I wouldn’t start from here is the punchline. When it comes to public policy, that wise Irishman has a real point.

Economists have a fancy name for it — path dependence. When considering policy options, there is no point getting a clean sheet of paper. You have to deal with what you have and tweak or modify policies, depending on your degree of political courage.

Where policy settings have been in place for long periods of time, as with Medicare, career and business decisions have been made and the electorate has built certain expectations based on their experience with the system.

Any major changes naturally upset many people and potentially create unintended consequences. This is one of the lessons from the government’s botched attempt to dramatically cut the Medicare rebate for short GP consultations.

This is not to deny the case for changing the Medicare system. But it is not clear that the principles set out by new Health Minister Sussan Ley are the right ones.

Her list is: protecting Medicare for the long term; ensuring bulk-billing remains available for vulnerable and concessional patients; maintaining high-quality care for all; and setting a price ­signal of a “modest co-payment” for those who have the capacity to pay.

Principles one and three are inane and obvious. Principles two and four sound worthy, but lack detail and possibly coherence.

One of my real concerns is the puerile and superficial nature of the debate about health policy. Do we learn much from Ley telling us that “in the last decade spending on Medicare has more than doub­led from $8 billion in 2004 to $20bn today, yet we raise only $10bn from the Medicare levy. Spending is projected to climb to $34bn in the next decade to 2024”.

In strong Churchillian terms, she declares, “My clear message to all is that doing nothing is not an option.”

This is all well and good, but other areas of government spending are expected to grow more rapidly than Medicare. The National Commission of Audit shows the fastest growing area of government expenditure over the next decade is likely to be childcare fee assistance and paid parental leave, ­leaving aside the national disability insurance scheme.

Does anyone mention that the surcharge on the Medicare levy will not fund the NDIS? Do we hear the government say that the growth in spending on childcare fee assistance and PPL is not sustainable and doing nothing is not an option? In fact, the Prime Minister thinks taxpayers should fork out even more for PPL and is likely to announce a significant ramping up of spending on childcare, inclu­ding subsidising nannies.

It is perhaps surprising the government has decided to target GP payments to save Medicare. On the most recent data, Medicare paid rebates for about 133 million GP item numbers, an average of just under six visits per head of population. A decade earlier, this figure was just under five visits.

But, during this decade, the proportion of the population aged 65 years or older rose more than a quarter. So age-adjusted utilisation rates of GP services have been relatively flat.

When it comes to the bulk-­billing rate — which Tony Abbott as health minister sought to ­increase — more than 80 per cent of all GP consultations involve no additional payment for the pat­ient. But bear in mind doctors are eligible for incentive payments for bulk-billing under-16s and concession cardholders who account for more than 70 per cent of bulk-billed GP consultations.

In reality, many GP practices have mixed billing arrangements and only bulk-bill concession cardholders and children. Other patients are charged a significant co-payment.

Sure, some non-concession cardholders receive bulk-billed services, but not as many as the government implies.

So when Sussan Ley says “some form of ‘price signal’ has to be ­imposed on visits to doctors to ease the pressure on Medicare”, she should realise a significant number of non-concession cardholders already face a “price signal” paying a substantial fee to see their GP.

Quarantining concession cardholders from any price signal is ­essentially a political decision — it doesn’t make much policy sense.

Higher income earners pay the Medicare levy and are forced to have private health insurance. And, when it comes to specialists, substantial co-payments are the norm for patients without concession cards (and for many concession cardholders, too). There could be some push back (from the Coa­lition’s base, in fact) if the government decides to impose an even steeper price signal for GP visits on this group.

Don’t get me wrong. I see lots of problems with Medicare, a curious mix of assurance and insurance. By rights, the only involvement of government should be to protect individuals from high-cost, low- probability occurrences involving long, expensive stays in hospital — catastrophe insurance. All the rest can be left to individuals to pay ­direct or though private insurance, possibly with taxpayer assistance for those on low incomes.

But, as we seek directions to Dublin, we need to acknowledge our starting point. With annual spending on hospitals expected to grow at more than 10 per cent a year for the next decade, perhaps that should be the focus of the new Health Minister rather than GPs.

Tweeting a lot of four-letter words about how miserable you are or how much you hate stuff? It may offer a glimpse into your heart health, new research shows.

University of Pennsylvania researchers studied 140 million random tweets from 2009 and 2010, and learned that what people said on the social media site correlated with heart disease mortality rates where those tweets originated. Twitter data also served as a window into psychological status, said lead researcher Johannes Eichstaedt, a Ph.D. candidate at the university.

"The single most predictive feature -- the single word predictor of heart disease -- is 'hate,'" Eichstaedt said. "You couldn't make this up."

The study was published this week in the journal Psychological Science.

Eichstaedt said communities where people tweeted more about hostility, hatred and fatigue were also more likely to have higher rates of heart disease, according to data from Twitter and the U.S. Centers for Disease Control and Prevention. On the flip side, areas where people tweeted about optimism seemed to have lower rates of heart disease, he said.

The researchers did not have access to the health status of individual Twitter users.

Having a reason to get out of bed in the morning seemed to be a protective factor when it came to heart disease, but the data predates the "#blessed" Twitter trend, Eichstaedt said. Getting the data from the social media giant today would be much more difficult and expensive, he said.

Cardiologist Dr. Sahil Parikh, at UH Case Medical Center in Cleveland, Ohio, said he applauds the researchers' creativity but said readers should take the results with a "very large grain of salt." He said it's "reasonable" to say that negative emotions related to stress can predict heart disease events because there's a significant body of research to back that up. But the age difference between social media users and people having heart attacks doesn't match up, he noted.

Men are considered more at risk for heart disease and heart attacks when they reach 55 years old, and women are considered more at risk at 65 years old, Parikh said.

"I don’t know how many 65-, 75-year-old women are out there tweeting," he said. "While there might be a lot of angry young people in a a certain area, I'm not sure how well that correlates with emotional well-being in those who are older and not Twitter users."

Eichstaedt said his team's research piggybacked on research about word frequency and psychological insight as well as their own work analyzing social media data. Eichstaedt's next project will be to see whether the Twitter data has any indication for other health issues, such as diabetes and cancer.

How do we cope in a world full of constant reminders to eat more junk food, drink more alcohol, have more friends, read more, post more, text more, and tweet more?

One emerging way of managing hyper-consumption is the "modern" fast.

Fasts have a long history in many societies and religions – Lent, Ramadan, Yom Kippur to name a few. They can relate to food, to alcohol, or to control of one's emotions, actions and speech. They are associated variously with repentance, self-denial, penance, or giving to others.

These fasts varied enormously in duration, intensity, selectivity and severity from the daily overnight fast, to much longer food fasts and perennial abstinence of various activities.

But in Buddha's day you didn't need to have a rest from junk food, alcopops, or Facebook, Twitter or your email. Now there is the technology to overload us in ways we have never seen before. And this is where the modern fasts, or variations on past themes help us cope with life's changing patterns.

Alcohol was the first with month-long fasts also doubling as fundraisers – FebFast, Dry July, Ocsober and more recently the three-month fast from alcohol promoted by Hello Sunday Morning.

These fasts also work by allowing the participants to signal to their friends and family that they are "having a break". As Jill Stark pointed out in her book High Sobriety, if you refuse a friend's offer of a drink it can be seen as breaking the social contract. By saying "'I'm FebFasting" it signals that you've got an endorsed and socially acceptable way of saying no thanks, I need to have a rest, while also reassuring your friends that taking a month off isn't an attack on their behaviour.

There is the 5:2 Fast, which has been rapidly and enthusiastically embraced by the MAMIL (Middle Aged Men in Lycra) and MAWIL (Middle Aged Women in Lycra) set. It is an intermittent fast on two days a week of eating minimally (600 calories for men, 500 for women), while being able to eat without restriction on the other five days.

Similarly, saying "I'm on a two day" means you can explain why you are having just lettuce and black coffee for lunch. The 5:2 Fast also works well for the chronic grazer – like me – in ensuring you have only two big decisions a week, on the fasting days, rather than trying to make hundreds of little decisions to eat a bit less all week. It has worked for me, with 6kg lost over 10 months. It is the intermittent nature that makes it do-able and stick-at-able for me.

Over the past couple of years FebFast has expanded from alcohol-only fasts to include sugar, junk food and smoking. And intriguingly they have introduced the digital fasts – taking a month off Facebook, Twitter, Instagram, Linked In, Tinder, Grinder, Tumbler or Snapchat.

Again, this allows participants to have an endorsed or sanctioned time off without being seen to be a recluse. It is a month where you don't have to either suffer everyone else's perfect Facebook lives or try to show you have a perfect one yourself. And of course you can reclaim an hour or two back every day that went into social media surfing (SMS).

Despite the known and accepted positives of social media – one being the capacity to encourage mass participation in events like FebFast – it can become counterproductive and unhealthy. So if you, or particularly your teenage children, are feeling the need to spend more of the day on social media, are planning constantly to use it, are feeling restless, anxious, or moody if you don't get to use it, or are ignoring other aspects of your life in favour of using new media, maybe it is time for a break, or a digital fast.

For me fasting is a great way to cope. I've had practice over many years of doing 10-day silent retreats – fasting from talking for 10 days (surprisingly easy), fasting from food from midday to breakfast (again pretty easy), fasting from caffeine (more difficult) and over the past few years taking a 10-day break from email and social media. This is the most difficult, as it turns out. What happens if someone wants me, or if I've missed an important world event or if I've been maligned by a nasty journalist again?

Do these month-long fasts work? Well, they certainly raise money (FebFast has raised $7 million over the past seven years for young people with addiction problems) and VicHealth's evaluation of FebFast has shown that nine out of 10 participants benefited from one or more positive outcomes, with the top three being saving money, sleeping better, and losing weight. You get a clearer head and tend to cope better as well.

A Canberra doctor who used leftover opioid anaesthetic from operations at Calvary Hospital has been found to have engaged in professional misconduct.

Calvary Hospital anaesthetics registrar Dr Michael Adams was using up to 300 micrograms of fentanyl, a powerful and addictive opiate analgesic, every day by September 2013.

He waited until the end of his shifts at Calvary to use what was left from operations on his patients.

Suspicions were raised when colleagues saw him take a 500-microgram vial of fentanyl at 8.20am in October 2013, for an operation not scheduled until after midday, and which was estimated to require only 150 to 250 micrograms.

His colleagues questioned him about it and he left the operating theatre, taking the vial with him.

The incident was reported to the Australian Health Practitioner Regulation Agency and Dr Adams, who trained in Cardiff, was told he could not work unsupervised.

He went to the coast, and his urine was tested and cleared of drugs by the time he got back, four days after the incident.

Dr Adams was interviewed about the drugs and said he had used some on his patient and discarded the rest.

He was told he would need to have his blood, urine, and hair tested. The blood and urine came back clear, but he refused to have the hair test.

The next month he attended for the test, but it could not be done because his pubic and underarm hair was waxed and he had a crew cut.

Dr Adams admitted his relapse into drug use to staff at Calvary Hospital, Canberra Hospital, and to his general practitioner.

He was suspended and the Medical Board of Australia took the case to the the ACT Civil and Administrative Tribunal, which published its finding of professional misconduct on Tuesday.

The decision revealed previous conduct by Dr Adams involving improper drug use at the hospital.

He used propofol, another anaesthetic, in early 2010, occasionally while still at Calvary, and at home.

He was found by an anaesthetics registrar in a drugged state in Calvary's registrar's bedroom in May 2010.

On Tuesday the tribunal severely restricted Dr Adams' ability to practice medicine. It also ordered that on his return to medical practice he not be allowed to work in any role involving anaesthesia for two years.

During that time he must always be supervised by someone who knows his history and he must have his work reviewed fortnightly.

Dr Adams will be prevented from prescribing certain types of medication, and is not to work more than 40 hours a week or overnight shifts.

He has been ordered to remain abstinent of drugs and alcohol for two years, and submit himself to urine, breath and hair screening.

The tribunal also told Dr Adams he must participate in a support and monitoring group for doctors, and go regularly to a treating general practitioner, psychiatrist, and psychologist.

He must also not self-prescribe or prescribe for close family members.

One cold Northern England evening in November 1990, when David Adam was a first-year college student in Leeds, he enjoyed an encouraging first date with a young woman that culminated in a bit of physical intimacy ending somewhere short of intercourse. The next day when a friend asked Adam if he had sex with the woman, he lied in the traditional manner of boastful, insecure young men everywhere and said that he had, without a condom. “You could have AIDS,” the friend said. That wasn’t true — or was, at most, exceedingly unlikely. Nevertheless, the idea lodged in Adam’s mind, where it set about establishing permanent residency. By the following summer, the fear that he might already have AIDS, or would someday contract it, had hijacked his brain. The “snowflake” of a single intrusive thought, as he puts it, had become a “blizzard” that “blew the snow into every corner of my mind, and laid down a blanket that muffled every surface.” For the next 20 years, Adam was consumed by the fear that he had contracted, or would contract, H.I.V.: He called the National AIDS Helpline so many times daily that the half-dozen staffers there came to recognize his voice; he got blood tests; he compulsively examined and re-examined every red stain he ever came across to determine whether it might be AIDS-tainted blood, and whether it might somehow have contaminated him. He knew this to be irrational — he was a science writer! — yet he couldn’t resist his compulsions. He had developed obsessive-compulsive disorder, or O.C.D.

Despite the distress his AIDS obsession caused him, he managed to live with, and to hide, his condition for years. But in 2010, at age 38, when his compulsions started to involve his young daughter — he once felt compelled to lift her into and out of a swing 11 times to test whether she might have picked up a spot of infected blood from the playground — he decided he’d had enough. The next day he made an appointment with his doctor, and began a course of treatment that included medication (200 daily milligrams of an S.S.R.I. antidepressant), group therapy and cognitive behavioral therapy, which in combination reduced his symptoms without altogether eliminating them.

Adam’s case history conveys a palpable sense of what it’s like to live in a brain possessed by obsessive thoughts, but it mainly serves as the launching point for a broad-ranging odyssey across the history and science of O.C.D. A writer and editor at Nature, Adam is a companionable Virgil, guiding the reader through the hellish circles of the disorder, explaining scientific concepts in clear, nontechnical prose.

Obsessive-compulsive disorder can make people do weird things. The mathematician Kurt Gödel was so afraid of tainted food that he would eat only portions his wife tasted first; after she became too ill to do this, he starved to death. The inventor Nikola Tesla spent the last 10 years of his life living in a hotel, eating at precisely 8 o’clock every evening, always using a stack of exactly 18 linen napkins to clean his cutlery; he felt compelled to walk around the block three times before entering his laboratory, and he was so afraid of germs that he would not allow his friends near him. My favorite anecdote from the book: A Canadian man whose O.C.D. was so unbearable that he attempted suicide by shooting himself in the head — but succeeded only in lobotomizing himself in such a way that he was cured. (“Do not try this at home,” Adam advises.)

So, what is O.C.D., which will afflict some 1 to 3 percent of us over the course of our lifetimes? As with so many mental afflictions, the answer is hardly straightforward. Is it a medical condition or a psychological one? That lobotomies and drugs can (sometimes) cure the disorder suggests it has a physical basis. Neuroscientists have found that it seems to be connected to disturbances in a part of the brain called the basal ganglia. (Disconcertingly, recent studies have found that strep infections in children can produce lasting O.C.D.-like symptoms.) Is O.C.D. a discrete syndrome or a subspecies of anxiety? For 33 years, the American Psychiatric Association classified it as an anxiety disorder — but in May 2013 the A.P.A. redesignated it as an impulse disorder, like Tourette’s syndrome. Is it caused by nature or by nurture? Freud famously attributed obsessive-compulsive disorder to guilt about childhood masturbation. Rather more convincingly, genetic research reveals a powerful hereditary component to obsessions and compulsions.

Yet genes or physical anomalies alone cannot account for the disorder’s cultural dimensions. Pathological obsessions tend to cluster around certain recurring preoccupations such as cleanliness and contamination; religious ritual; a need for symmetry or patterns; and unwanted thoughts of violence and sex (which, crucially, are almost never acted upon by O.C.D. patients). Evolutionary biologists theorize that obsessive-compulsive disorder may be a “psychological immune system” gone awry — for instance, adaptive traits (like avoiding contaminated food) that when properly deployed help keep humans alive become damaging psychopathology when misdirected or overstimulated.

For sufferers, the thirst for relief from intrusive thoughts and compulsions can be unending and, ultimately, unquenchable. David Adam’s book should provide them with consolation (you are not alone) and hope (he’s much better now) — and it provides all readers with a fascinating glimpse of an unusual but enduring form of psychopathology that sheds light on how our ­elegantly evolutionarily designed brains can give rise to minds that sometimes work in painful, maladaptive ways.

The NSW government's clinical trial of medicinal cannabis is inappropriate for patients suffering extreme pain, and the drug should be legally approved for patients diagnosed by doctors, a paper in a top medical journal argues.

"We are behind the times on medical cannabis," writes David Penington, an emeritus professor at Melbourne University, in a paper in the Medical Journal of Australia on Sunday.

"Twenty three states in the US have legalised use of cannabis for medical conditions, as has Canada since 2001. Other countries approving it include Israel, Holland and the Czech Republic."

Dr Penington, a public health and medicinal marijuana advocate, was named the 2014 Victorian of the Year.

Under the terms of a clinical trial unveiled last year, the Baird government will run a trial of clinical cannabis for approved conditions including pain associated with terminal illness, children with intractable epilepsy and chemotherapy-related nausea.

Trials are expected to start next year.

Under the terms of the trial one group of patients will be treated with a placebo and one with active cannabis preparations. The progress of the two groups will be compared.

But Dr Penington says the government should approve use of medicinal cannabis now, pointing to a study showing 76 per cent of readers of one medical journal recommend cannabis be prescribed for cancer patients.

He further argues that the mechanics of running a double-blind study are not appropriate for patients, particularly those in extreme pain.

"Cannabis as such cannot be subjected to a double blind clinical trial," they write. "If a person in the late stages of painful cancer seeks the euphoria of THC, why should they not have it?

"Participants in the control group may demand to transfer to the active arm on seeing others feeling better."

The government is examining options to import cannabis for the trial, or have it grown under controlled conditions by contract from the government.

But Dr Penington says patients who register with the government should instead be allowed to grow up to 10 of their own plants to establish a supply.

He notes it could still take several years to conduct trials of pharmaceutical cannabis compounds for epilepsy.

The state's Opposition Leader, Luke Foley, has announced that he favours moving directly to legalisation of medical marijuana.

John Kaye, from the NSW Greens, also advocates snap legalisation and introduced a bill to parliament that would allow patients suffering a range of conditions to grow up to six of their own plants.

A SHORTAGE of doctors in the Gladstone region could eventually be a thing of the past.

The Federal Government has declared the region to be a District of Workplace Shortage, which will provide more opportunities for GPs to practice here.

However, according to Gladstone GP Superclinic principal Dr John Bird, the declaration could be a double-edged sword.

"We need more doctors here. There's nothing more certain than that," he said.

"However, the declaration of a DWS opens the door for overseas-trained doctors, but not so much for Australian-trained doctors."

That's because the Medicare system provides lesser rebates to qualified Australian-trained doctors, unless the doctor is in a supervised training position.

But there are few training places available in Gladstone and similar towns for Australian-trained graduates.

Dr Bird said he knew of at least two qualified doctors in Gladstone who would like to train as specialist GPs and work in general practice, but they couldn't because of the shortcomings of the Medicare system.

"If an overseas-trained doctor comes to Gladstone, his patients will be entitled to the full $37 rebate from Medicare.

"However, with the Australian-trained doctors, the patient's rebate may be just $21," he said.

"Under the changes which are due to take effect on July 1, the $21 reduces to $16, making the position even more untenable.

"Patients will not be prepared to pay that much extra themselves to see a doctor and they are likely to head to the hospital's emergency department, and then the cost of treating that patient becomes a total cost to the state government."

A spokeswoman for the Federal Department of Health said no Australian doctor would be disadvantaged by an area being DWS or not.

"However, there is a competitive process that is open to all doctors wanting to become GPs each year, 1500 places are available, and 50% of these are in regional and rural areas like Gladstone," she said.

"If these two doctors missed out on training places, this is likely to be because they didn't meet the standards required by the RACGP and ACRRM, not because they are being displaced by overseas-trained doctors."

The parents of two young girls are rallying in the face of an unimaginable challenge — each of them is fighting cancer.

US couple Ben and Shelby Offrink, of Lowell, Michigan, are parents to Maeve, 3, and 14-month-old Hazel.

Shortly after giving birth to Hazel prematurely, Shelby discovered she had Grade IV glioblastoma of the spine, one of the rarest forms of cancer.

Then in August, her husband Ben’s Hodgkins Lymphona returned for a third time. His first chemo treatment failed and he will have a second, but doctors say he will require a bone-marrow transplant.

“It’s just shocking, you know? At first it just seemed like a terrible dream,” Shelby’s younger brother Luke Tomczak told KSDK.com.

Friends and family have rallied as Shelby receives treatment to extend her life. After months of radiation and chemo, last month doctors found three new tumours on Shelby’s brain.

“She has an intelligent, witty sense of humour and I’m really happy she has been able to maintain that throughout all of this,” Jay Tomczak, shelby’s older brother, said. “Shelby has always been the strongest person that I’ve known.”

Friends are fundraising for the couple via a web page, which also keeps donors up-to-date with the family’s progress.

Before the family were knocked by the double diagnoses, Shelby worked as an engineer and Ben was a stay-at-home dad.

When a doctor tells a patient that she has cancer and has just a year left to live, that patient often hears very little afterward. It's as though the physician said "cancer" and then "blah, blah, blah."

Anxiety makes it difficult to remember details – and the worse the prognosis, the less the patient tends to remember. Recent studies have found that cancer patients retain less than half of what their doctors tell them.

So it's not surprising, perhaps, that a patient with advanced cancer can leave her oncology appointment thinking she has a set amount of time left to live. "The doctor gave me a year," she'll say, as though she were a half-gallon of milk with a "sell-by" date printed on her head.

But prognoses are almost never that clear-cut, despite the fact that patients need to make big decisions based on those numbers. Should she quit her job? Take that dream cruise? Write a living will?

Physicians play a part in the confusion, too. Doctors consistently overestimate how long a patient has to live, according several studies. In one study of terminally ill patients, just 20 percent of physician predictions were accurate. The majority, 63 percent, were overoptimistic.

And if patients think a doctor is doing a good job of communicating with them, they're more likely to be erroneously optimistic about a cure. That can keep patients from fulfilling key goals before they die.

One big challenge is that a prognosis is not an absolute number. Doctors often look up data gathered by the National Cancer Institute or the American Cancer Society, or they will use their own clinical expertise.

The data are typically given as a median, which is different from an average. A median is the middle of a range. So if a patient is told she has a year median survival, it means that half of similar patients will be alive at the end of a year and half will have died. It's possible that the person's cancer will advance quickly and she will live less than the median. Or, if she is in good health and has access to the latest in treatments, she might outlive the median, sometimes by many years.

Doctors think of the number as a median, but patients usually understand it as an absolute number, according to Dr. Tomer Levin, a psychiatrist who works with cancer patients and doctors at Memorial Sloan Kettering Cancer Center in New York. He thinks there is a breakdown in communication between the doctor and patient when it comes to the prognostic discussion.

Levin and other people who work on the social and emotional side of cancer – psychiatrists, psychologists, behavioral scientists – are training people who treat cancer on how to make the conversation easier for everyone.

During a two-day session at Memorial Sloan Kettering on communicating with cancer patients, three doctors were brought to a small room, where they practiced giving a prognosis to an actor.

The doctors were encouraged to set an agenda for the discussion, ask the patient what he or she wanted from the session, and to present the prognosis as a best-case, worst-case and most likely scenario. They were encouraged to tell patients to prepare for all three scenarios, and to write down the prognosis so the patient would remember the specifics. The best-case scenario helps to preserve hope, and that hope is not simply a warm feeling — 1 in 10 patients do much better than the median survival time for their cancer.

But many people avoid preparing for the worst-case scenario, Levin says, "because the worst-case scenario is the scariest." Sometimes a family's desire to "think positive" can make people reluctant to bring up death or dying. "And the end result is that the patient is left alone with his fear of dying and he can't speak to anyone about it." Levin also wants the doctors to make it clear to their patients that they will not abandon them if the worst-case scenario comes to pass.

During the role-playing session, Dr. Asma Latif sat across from an actress portraying a 42-year-old woman with stage III ovarian cancer.

"The goal of the treatment is to cure the cancer," she said to the pretend patient. "But we know that this often is not possible. And actually the most likely scenario is that we don't cure the cancer. And I" - Latif paused. She could see that the patient was becoming visibly distressed by the uncertainty of her prognosis. "Can I do a time out? I don't know how to recover from this."

Latif was struggling with giving a prognosis that had a wide and vague range of outcomes. Levin assured her that while it seemed cumbersome, it was more honest and would help patients make difficult life decisions.

Ultimately, Latif agreed that she would try this with her patients, that she could see the value in it. But after the role-playing was done, all three doctors agreed that this session was more difficult than others they had undertaken, even more than discussing death and dying.

New research suggests that stress makes it more difficult for women to recover from a heart attack.

Researchers at Yale University found that young and middle-aged women experience more stress than their male counterparts, which could contribute to worse recovery from acute myocardial infarction (AMI).

"Women tend to report greater stress and more stressful life events than men, potentially because of their different roles in family life and work, as compared to men," Xiao Xu, first author of the study, said in a statement. "This difference in the level of stress may be an important reason for sex-based differences in recovery after acute myocardial infarction."

For the study, Xu and colleagues collected and analyzed data from the Variation in Recovery: Role of Gender Outcomes on Young AMI Patients (VIRGO) study, which involved a diverse network of 103 hospitals in the United States, 24 in Spain and 3 in Australia from 2008 to 2012.

They found that compared with men, women had significantly higher rates of diabetes, chronic lung disease, chronic renal dysfunction, depression, and cancer, as well as previous stents, congestive heart failure, and stroke. Women were also more likely to have children or grandchildren living in their household, while experiencing greater financial strain.

"This study is distinctive in focusing particularly on young women and going beyond traditional predictors of risk to reveal how the context of these people's lives influences their prognosis," Harlan M. Krumholz, senior author of the study, said in a statement. "Helping patients develop positive attitudes and coping skills for stressful situations may not only improve their psychological well-being, but also help recovery after AMI. Stress management interventions that recognize and address different sources of stress for men and women would be beneficial."

Irish scientists have identified a potent molecule that may be able to halt the progress of deadly diseases such as Alzheimers and multiple sclerosis.

Research scientists at Trinity College in Dublin have also found that the molecule’s anti-inflammatory properties can stop a variety of other serious conditions in their tracks, among them diabetes and gout.

In the study to be published this week in the medical journal Nature Medicine, the international research, team led by Trinity and the University of Queensland in Australia, showed how the molecule MCC950 can suppress the ‘NLRP3 inflammasome’, which is an activator of the key process in inflammatory diseases.

“It is a bit like a cog in a machine that drives these diseases,” said Luke O’Neill, professor of biochemistry and director of Trinity Biomedical Sciences Institute. “I would not go as far as to say that what we have is a cure for all of them but, because they share an inflammatory component, this molecule can stop their progression.”

The discovery confirms that inflammatory diseases all share a common process, even though the part of the body becoming inflamed might differ.

“In Alzheimers it’s the brain; in gout, it’s the big toe; in arthritis it’s in the joints,” said Prof O’Neill. “It may seem strange but the underlying process is shared in all of these conditions.”

Prof O’Neill described the discovery as one of the most exciting of his career. “I have been in the research business for 30 years and you usually end in failure, but this time we seem to have hit upon something truly transformative,” he said.

“We believe this has real potential to benefit patients suffering from several highly debilitating diseases, where there is currently a dire need for new medicines. Drugs like aspirin or steroids can work in several diseases, but can have side effects or be ineffective.”

Rebecca Coll, lead author on the paper, who conducted some of the work at Trinity, said: “MCC950 is blocking what was suspected to be a key process in inflammation. There is huge interest in NLRP3 both among medical researchers and pharmaceutical companies and we feel our work makes a significant contribution to the efforts to find new medicines to limit it.”

Matt Cooper, chemist and co-senior author from the University of Queensland’s Institute for Molecular Bioscience (IMB), added: “MCC950 is able to be given orally and will be cheaper to produce than protein-based treatments.

“Importantly, it will also have a shorter duration in the body, allowing clinicians to stop the anti-inflammatory action of the drug if the patient ever needed to switch their immune response back to 100% in order to clear an infection.”

So far, the results have shown great promise for blocking multiple sclerosis in a model of that disease, as well as in sepsis, where in response to bacteria, blood poisoning occurs.

A FOLEY Labor Government will require NSW's almost 900 aged care facilities to have a registered nurse on duty at all times.

NSW Deputy Opposition Leader and Shadow Minister for Ageing and Disability Services Linda Burney said as part of its health policy, a Labor Government would legislate to extend the legal requirement that NSW aged care facilities must have a registered nurse on duty at all times.

"Having senior nurses in NSW aged care facilities is good for the well-being of residents and provides peace of mind to family members with loved ones in nursing homes," Ms Burney said.

"This measure also support nurses and protects aged care residents, particularly those in high care - who are among the most vulnerable in our society.

"We make no apologies for improving the health and well-being of aged care residents. This is about ensuring that NSW aged care residents have the best possible care."

Currently, the registered nurse requirement is only in place in NSW until December 2015 - and NSW is the only Australian jurisdiction with this requirement.

The NSW Public Health Act 2010 requires all 'nursing homes' in NSW to have a registered nurse on duty 24 hours a day seven days a week, but, last year, changes to the Commonwealth Aged Care Act 1997 by the Abbott Government impacted on the NSW Public Health Act. This removed the requirement of a registered nurse.

However, on June 13, 2014, NSW Health Minister Jillian Skinner wrote to the NSW aged care sector putting forward an interim measure until December 2015. She said she wanted to consult with nursing home operators. Labor will make the registered nurse requirement permanent.

Under the NSW Public Health Act 2010, failure to comply with the registered nurse requirement carries a maximum penalty of 100 penalty units or a $11,000 fine.

There are about 880 Commonwealth-accredited aged care facilities in NSW run by some 300 aged care providers.

The NSW Nurses and Midwives Association has been calling for registered nurses in aged care facilities.

Victorian hospitals are having to manage more cases of severely obese women during pregnancy, prompting obstetricians to warn that excessive maternal weight poses greater risk to unborn babies than smoking.

As the rate of obesity in the community continues to rise, obstetricians say the risks it poses to women and babies during pregnancy and labour are not widely understood.

The care of obese women - and the issue of when they should be transferred to major city hospitals - has come under the spotlight following the death of baby Mabel Windmill shortly after she was born at Latrobe Valley Regional Hospital in 2012.

The Victorian Coroner's Court heard Mabel could have survived if born earlier but her obstetrician believed a vaginal delivery was safer for her mother, Kathryn, whose high body mass index put her at increased risk of complications.

The case both highlighted the risks faced by obese mothers and raised questions about whether Victorian hospitals, particularly in regional areas, are equipped to manage their care.

Monash Health director of obstetrics Euan Wallace said obesity in pregnancy had emerged as a major problem only over the past decade, and was becoming more extreme.

A healthy body mass index – or BMI, an estimate of fat based on a person's height and weight – is between 18.5 and 24.9 for an adult. An obese woman has a BMI of more than 30.

"Ten years ago we would not have seen anyone with a BMI of 50, but now we'll see one or two women a month," Professor Wallace said.

"I had never, until the last couple of years, seen a women with a BMI of 60, but we'll now see half a dozen a year," he said.

Some women seen by specialised clinics at major Melbourne hospitals weigh more than 150 kilograms.

Professor Wallace said the risks to mothers and babies increased with BMI. At the high end, probably above 40, women could not be safely cared for in small centres.

He said caesarean sections for such women were "incredibly complicated surgeries with extremely high rates of complications".

"When we have a woman with a BMI of 50 needing a caesarean section we would have several pairs of very senior hands on board, [including] specialist anaesthetists, obstetricians and paediatricians," he said.

Mercy Hospital for Women director of perinatal medicine Professor Sue Walker said as BMIs kept creeping up, there was a danger of "normalising" problems of excess weight, particularly at the lower end of the spectrum.

"In the community, we've got used to regarding relatively low increases in BMI as being normal. But it's important for us to take time to assess a woman's BMI and stratify the risks that we should be looking out for during pregnancy," she said.

"The scale of it means that we need to be thinking about this in every area of maternity care. It's not just an outlier anymore but part of the mainstream population."

Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Professor Michael Permezel said smaller hospitals usually had "bariatric policies" for pregnant women giving an upper weight limit beyond which they would transfer care to a larger centre.

He said some hospitals were not clinically equipped to manage women with very high BMIs, and women needed to be cared for elsewhere "in the best interest of their own health and that of their baby".

Professor Wallace said he believed greater efforts were needed to develop a "seamless chain of service" where women could move up from a rural, regional to tertiary hospital as their risks increased.

"We've had referrals at the 11th hour. A referral with one week to go is a very unsafe referral - it's very little time to meet with the woman and talk with her and plan things that could've been planned months ahead," he said.

He said a regional structure would overcome such difficulties, and women should not always be transferred to city hospitals.

"I think a much more acceptable and less stigmatising solution is to ensure the capabilities of regional centres can meet the needs of these women, and I think in most cases they do," he said.

"In some cases they have been less proactive and they have been caught out so they've recognised all of a sudden, we've got women we can't look after safely, and that just needs a bit of planning and support."

Professor Wallace said public hospitals needed to respond to the needs of the population by caring for obese women in pregnancy, but also highlight what was a worrying trend.

"It's become much worse than smoking. Women with a BMI of over 50, the outcomes of those pregnancies are worse than for women who smoke," he said.

"We need to be feeding back and having this conversation. This is a huge health burden for our society, and we need to think about how to start reversing it."

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